Sierra Leone


Barba Musa, 43 years old, has been a community health officer for 18 years. Photo credit: Mats Lignell/Save the Children

Since 2011, Barba Musa has worked in Kroo Bay, one of the slum areas in Freetown, the capital of Sierra Leone. “A lot of women come here” he says. “Since free health care started there is no barrier, every day they come. They keep us very busy.

I’m in charge of the centre and we serve almost 20,000 people. We don’t have enough members of staff… not since the free healthcare reform. There are eight community health nurses and me, and we work in three shifts. One nurse stays overnight so that there’s someone at the health centre at all times. 20-30 people come on an average day and almost all are mothers. The men don’t come to us – they go to the nearby government hospital.

The main problem in Freetown has always been lack of access to healthcare and it’s because of money. The free health care system for pregnant mothers and children under five means that they visit the clinic in time and so far, in the last year there has been no maternal death among the community that the health centre serves. I want to see the politicians implement the free healthcare system better. It’s not easy – we need more drugs because sometimes we don’t have drugs to give to the patients. I want them to really implement it well. I want to see free healthcare for all.”

Neonatal mortality rate  (per 1,000 live births) (2011) 49
Under-five mortality rate (per 1,000 live births) (2011) 185
Maternal mortality ratio (per 100,000 live births) (2010) 890
Number of doctors, nurses and midwives per 10,000 people (2010) 1.9
Births attended by skilled personnel (2010) 60.8%
Total expenditure on health as a percentage of gross domestic product (2011) 18.8%
General government expenditure on health as a percentage of total expenditure on health (2011) 18%

Sierra Leone’s ‘Free Healthcare Initiative’ was launched in April 2010 to increase access to key healthcare services by removing user fees for priority groups, specifically, pregnant women, lactating mothers, and children under five. As part of this initiative health worker salaries were increased and the quality of human resources for health payroll data and information systems has improved. The distribution of health workers across the country remains inequitable and further supportive HRH policies need to be introduced to improve motivation and quality of care.

The proportion of national GDP allocated to health is high compared to other countries though this is still insufficient to meet the full health needs of the population.

Sierra Leone’s Agenda for Prosperity (2013-2018) recognises the shortage of qualified human resources for health both in terms of quantity and quality in all areas of service delivery. It commits to strengthen health training institutions to provide sufficient skilled health personnel; enhance skills of health workers at all levels to deliver quality health care services through the establishment of a continued professional development scheme; start local post-graduate training of health professionals; improve the efficiency, equity and effectiveness in staff utilisation; and further strengthen the human resources management system.

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